Hirsutism history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2] Rasam Hajiannasab M.D.[3], Ahmed Younes M.B.B.CH [4]

The hallmark of hirsutism is excessive facial hair growth. A positive history of virilizing symptoms is suggestive of an underlying hormonal imbalance. The most important points in history taking regarding hirsutism in patients include: Age of onset, family history, and severity/progression.

• A good and accurate history of the onset and developmental milestones are important and useful in making a diagnosis of hirsutism.^[1]

• During puberty
  • Mainly due to idiopathic hirsutism and other less serious causes of hirsutism
• Hirsutism in middle-aged or older women
  • May suggest an adrenal or ovarian tumor

• Congenital adrenal hyperplasia (CAH) in a patient with a family history of hirsutism is consistent with the diagnosis. Idiopathic hirsutism and polycystic ovary syndrome (PCOS) could also be familial and may be suggestive in making a diagnosis.

• A benign form of hirsutism is usually characterized by pubertal onset with slow progression over many years. This is often true of hirsutism with PCOS.
• An androgen-secreting tumor is a possibility with a history of rapid severe hirsutism or other signs of virilization.
• Adrenarche and Puberty: Early development of pubic hair is a pointer towards CAH.

• Patients must be assessed regarding the presence or lack of virilizing signs such as:^[2]
  • Change in the voice or deepening voice
  • Male pattern baldness
  • Excess facial and body hair
  • Clitoromegaly (enlargement of the clitoris)
  • Increased muscle mass
  • Acne
  • Decreased breast size
• Amenorrhea
• Increased libido
• Signs of insulin resistance (eg, acanthosis nigricans, abdominal obesity)